Revised cardiac risk index as predictor of cardiac complications in patients undergoing uniportal vats lung resections

Background Revised Cardiac Risk Index (RCRI), or Lee Score, is a multivariable predictive index for perioperative cardiac complications and it seems to discriminate moderately well between patients at high versus low risk for perioperative cardiac events. Aim of this study was to evaluate the sensibility of RCRI in patients undergoing Uniportal Vats (U-VATS) interventions.
Methods A retrospective observational study involving 324 patients who underwent U-VATS interventions was performed. Data extracted from an anonymous database concerned demographic information, diagnosis, type of surgery, tobacco habit, American Society of Anesthesiologists (ASA) classification, comorbidity, duration of anesthesia, duration of surgery, type of operation, duration of eventual admission to intensive care, duration of postoperative hospitalization, cardiovascular and non-cardiovascular postoperative complications, 30-days mortality. For each patient, the RCRI was calculated retrospectively.
Results Records from 324 patients, 165 (50.9%) of which were male, were considered. The mean age of the population was 61.4 years. The most frequent diagnosis at admission was “lung cancer”, followed by “lung metastasis”. The most frequent type of surgery performed was the “atypical resection”, followed by “lobectomy”. The most frequent ASA index was level “2”, found in 209 patients (64.5%). Cardiac complications had been experienced by 3 patients (0.9%). The sensibility of the RCRI was 33.3%, its specificity 97.8%, with a Positive Predictive Value of 12.5% and a Negative Predictive Value of 99.3%.
Conclusions U-Vats represents a new frontier in thoracic surgery. The mean age of the general population is increasing, and so is the mean age of patients entering the operating room for U-VATS lung surgery. The presence of a preoperative score could help the anesthesiologist to identify patients at risk of developing postoperative cardiac complications and choose the appropriate anesthesiologic approach. RCRI could be a useful prognostic score in VATS, but further studies are needed to support this statement.